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No Child Left Undiagnosed

"Sluggish Cognitive Tempo" may possibly be the very dumbest and most dangerous diagnostic idea I have ever encountered.

And I have seen some beauts during my 40 years of shooting down crazy new diagnostic dream lists. The wild suggestions are usually created by "experts" brim full with diagnostic exuberance-- sometimes well meaning, sometimes influenced by extensive drug company affiliations--and always ungoverned by simple common sense, a respect for scientific evidence, and an appropriate fear of risky unintended consequences.

Alan Schwarz is a brilliant investigative reporter for The New York Times who has dug deep into the fake epidemic of Attention Deficit Disorder. If anyone in your family has been diagnosed with ADHD, you should definitely Google his revealing series of reports detailing the how's and why's of ADHD misdiagnosis and the consequent harms of over-medicating our kids with stimulant drugs.

In today's New York Times, Schwarz reports on the latest bizarre twist. The very same experts who succeeded in promoting ADHD have now concocted and are promoting a new diagnosis that would be a terrific bonanza for pharmaceuticals, but terrible for the kids who would be misdiagnosed and over-treated. (nytimes.com/idea-of-new-attention-disorder-spurs-research-and-debate)

Sluggish Cognitive Tempo is a remarkably silly name for an even sillier proposal. Its main characteristics are vaguely described but include some combination daydreaming, lethargy, and slow mental processing. Its proponents estimate that SCT afflicts approximately 2 million children. Not surprisingly, Eli Lilly is already on the case.

The Journal of Abnormal Child Psychology is also taking all this very seriously. SCT is featured in 136 pages of its January issue. Included are claims that the question of its existence “seems to be laid to rest as of this issue” and that SCT is gaining momentum toward recognition as a legitimate disorder.

However ludicrous SCT may seem, the risk it may do great harm is real. Child psychology/psychiatry/pediatrics/family medicine have become fevered fields of diagnostic excess, pharmaceutical manipulation, and careless medication prescription. In just 20 years, rates of ADHD have tripled and Autism and childhoodBipolar Disorder have increased 40-fold.

A prospective study using DSM-IV found that by age 21, 81 percent of kids had already qualified for one diagnosis of mental disorder. DSM-5 recently made things much worse when it turned normal temper tantrums into Disruptive Mood Dysregulation Disorder. The last thing our kids need is to be misdiagnosed with Sluggish Cognitive Tempo and bathed in even more stimulant meds.

Alice, trapped in Wonderland, has this instructive conversation with the Cheshire Cat:

Egged on by well meaning (and not so well meaning) experts and by greedy drug companies, we are fast approaching this dystopic wonderland of universal childhood mental illness. I would be in despair were it not for my belief that diagnostic exuberance has overplayed its hand and is ripe for a very big humpty-dumpty type fall. More on this in my next blog.

"No Child Left Undiagnosed" ?
An alternative title might be "No child left free from the conformity enforcers"
Because enforcing conformity is ultimately what it is about (plus the profit motive of course)

Excellent and much needed 'voice of reason'. Is it that adults are so far removed from really seeing children and understanding their needs in terms of what is 'normal' given the way they are being raised, that is why medication is reached for with such ease?

As adults are increasingly pre-occupied and emotionally unavailable to children in all aspects of life is it any wonder that drugging them to fit into this can see OK?

While skepticism is important and necessary to keeping overeager researchers and pharmaceutical interests in check, the public deserves some balanced debate, especially when it's coming from a someone of Dr. Frances' experience and prestige. This is not a black-and-white issue by any means. Clinical researchers are not slaves to pharmaceuticals, nor are they immune to their influence. This is an issue involves the complex interaction of the interests of clinicians, researchers, pharmaceutical companies, clinical populations seeking help, and the general population.

Dr. Frances neglects to present this complexity, nor does he back up his attack on all sluggish cognitive tempo research with any citations of relevant research for or against his views, aside from Alan Schwarz's NYT article.

It seems that, when it comes to polemic diagnostic issues such as ADHD, those who speak out either express total neglect of the research or express total neglect of the controversy surrounding it. No one seems to be weighing both sides of the story, and I had hoped that someone with Dr. Frances' credentials would've been able to provide some much-needed balanced commentary.

As an adult who's life long pathology seemingly conforms to this prospective subtype, I appreciate your tempered and well reasoned rebuttal to this somewhat myopic and hyperbole-riddled article. To be smote with all of the typical ADHD-PI symptoms, coupled with perpetual lethargy is so debilitating it verily snuffs out any quality of life. While I wholly know that I wont see any advancements in treatment options during my lifetime, at the very least it's a little comforting that some academic validation of this malady is starting to percolate. Being both an adult and a medical student contending with this condition, I'm in a unique position to articulate to the corporeality of SCT. I truly believe this to be a correlate of attention deficit disorder as it truly presents as an impermeable "brain fog."

I agree with anonymous. Regardless of if SCT is true or not, or in the end if it's just a sub-characteristic of ADHD-I, the SCT symptoms are very real for me, and I don't appreciate this person calling it all "silly". I often feel like the world goes by so fast multi-tasking, and I am like this exhausted turtle who can barely maintain the energy or ability to take in new information. I've been heavily distracted by my inattentiveness since I was very small. Later on, I remember on several occasions needing to study for exams and I could never get past the 1st or 2nd page without confusion of the topic, sleepiness, and an inability to retain the information. The less interesting the topic the worse. Of course, being in graduate school (I somehow got by in private schools- high school and undergrad) , I'm learning to manage my time and to develop skills for myself to manage whatever it is that makes studying so difficult, but the whole issue with retaining information even for simple things like a daily to-do list (it has to be written down, and I have to look at it constantly to remember), is still a persistent issue. This is why I have a hard time getting many things done that quickly, because half of my energy is going towards just trying to remember everything I have to do and not getting overwhelmed by it all. And then I need a small portion of my week dedicated to just relaxing because my brain fog/brain noise will be just too exhausting. I will be seeing a specialist about this soon. I will admit, no I did not have parents who thought I had serious difficulty or at least they didn't know how to help me since teachers and professionals alike were not sure what I was enduring, so I didn't actually try to manage it until very recently with time-management and exercise. Whether my symptoms have been caused by a combination of several things or not, I need more insight and this article does not provide a solution for me other then to google Alan.

As an adoptive mother trying to help my daughter prepare for adulthood, I am very interested to learn about this possible condition and suggestions to help her. We just visited her birthmom who has several older children and they are all living on tax payer money. Nice, reasonably intelligent people who can't seem to get their act together for some reason. They could be contributing to society instead of being underachievers. It is love that motivates us to help people overcome life's challenges. Why dismiss the existence of this possible condition if a cluster of these symptoms are prevalent and preventing people from living a stable, independent life? We all must conform to some degree to have an orderly, functioning society. If these symptoms are keeping people from functioning in society, why would anyone prevent them from getting some help? Keep an open mind!

I agree with everything stated here. I have kids with diagnosis of ADHD because of pushing from the school. One child was on meds for it. I have another child who would fall into that diagnosis of SCT but I know better. When he's interested in what he's learning that "SCT" goes out the window. I've recently taken my kids out of traditional schooling and am now in the process of unschooling. I also took my child off of the meds. I'm going to let them lead the way as far as their education is concerned. I've had enough of schools trying to run my life and getting overly involved in my kids health and trying to get in the way of my parenting. No more.

Even when I am interested in a topic, I still get tired and sluggish. Just stating my experience. I'm not trying to credit SCT as being valid, but I'd like to think that my inattentiveness even with subjects that I enjoy, merits more research.

Though I do agree with the doctor that SCT is a ridiculous name, I completely disagree with his dismissal of it as a credible disorder. For the first time in my life I've been able to completely identify the symptoms that have plagued me my whole life with SCT. I was diagnosed as ADD but not ADHD and take low dose Adderall and every supplement under the sun that has been shown to help with my multitude of SCT-like symptoms. I was always identified as a "quiet, shy, very bright child with a tendency to daydream." I outgrew the shyness and the term "daydreamer" was eventually changed to "unfocused" and "a procrastinator." I can understand writing off some of the SCT symptoms as normal childlike behavior, but when the same symptoms that mirror the SCT diagnosis continue to plague you well into your late 40s I think some credence should be given to the fact that this is a legit disorder that is not ADHD and should be diagnosed and treated for what it is. By publishing an article attempting to expose what Dr. Frances thinks is nothing more than big pharma trying to cash in on some "dumb and dangerous diagnostic idea", he's created and proliferated an attitude of dismissal amongst those who can't understand or assimilate to something I live with everyday. These people will continue to label those like myself as "scatterbrained" and "disorganized" even though we are desperately struggling to find a way not to be like this.Even though Dr. Frances believes this disorder identification isn't credible, he should at least have the decency to respect the work of his peers. He is doing himself and everyone else trying to find help with this disorder (via meds or alternative treatments) a great disservice by wasting time writing an article lambasting the research of others and offering no alternative diagnosis for something that is not some diagnostic unicorn. I work in the medical world and agree that big pharma is not doing what they do out of the goodness of their hearts but sometimes it accidentally helps people (including children).

I would agree with SCT survivor, the symptoms that are described are real. I have always found it difficult to process information quickly, especially when it is spoken, and have struggled with films, lectures and any in depth conversation, although I am considered ‘bright’ (I have a degree and have published several scientific papers). I also have a very poor memory, so find it hard to stay focused as I sometimes forget what I am doing and move on to something else. Then I remember and go back. At school I was a daydreamer and told I could do well if I tried harder. I have never been diagnosed, so I don’t have medication, but I have found strategies that work for me. I make copious notes and lists to keep myself focused at work, I use manuals rather than follow verbal instructions, and I read synopses of films before I watch them so I know the rough story line. I have found though, that when I am working on a particularly exciting project at work, I become hyperactive and very proactive, although this doesn’t mean that I process information any better, I just appear to be doing so. We are all, as human beings, variable in our strengths and weaknesses, and in our cognitive abilities. I believe what is needed is not more medication (although I appreciate that more severe cases find it necessary), but an awareness and acceptance of these differences, and teaching skills to cope.

My son was diagnosed with SCT and the 20mg Vyvanse has been a God send. He became so withdrawn by 4th grade that he would just face the back of the room and stare all day. He couldn't understand how all of the kids moved so quickly because it would take him 30 minutes to decide on a sentence. It is not boring content - there is no amount of interest that makes him pull out of a fog. Here is how my 11 year old describes it "mom - it is like when you have the flu and we are talking to you but you just don't respond because you are too tired - that is how I feel all of the time." It takes so much energy to just listen to a simple request that he is exhausted by the time he walks in the school. Like a hyper child or an Alzheimer's patient - it varies from day to day. He could do complicated math one day and the next not be able to remember simple multiplication. He has days that he is incapable of functioning - just doesn't respond to anyone who speaks to him. He was falling further and further behind when one teacher that everyone hailed as amazing (she was fun and exciting but talked fast) pushed him over the edge. He just sat catatonic. He said that she scared him and he couldn't understand her. The meds are very helpful to him. He still processes slow but the medication fills the gap. He is MUCH slower than normal kids on bad days but on most days he is normal. What people don't understand - this is not something that just hits them at school. We have SCT stories from Disney World where he just stood there catatonic. There are other things we do to help him out. He exercises 1 hour a day - 7 days a week. He eats healthy. He is learning to notice when he is completely foggy and tries to do things that will help him. I don't think of him as disabled. He is fine. He is smart. With the medication - he will get educated. He will learn to adjust and now I know that he will succeed in life. Before - this is a kid that would have been labeled lazy and stupid. Written off. He will do just fine. We laugh because we know that he will have limitations on careers - who would want a neurosurgeon that goes into catatonic trances. LOL. But he is so happy with the medication because he is not lost and scared. He feels normal and there is no amount of words I could use to tell you how happy that makes him. It is all he wants. Dumb diagnosis - ok but it doesn't matter what the "right" diagnosis is. This is a kid that was not functioning at home, school or with friends. He is now a kid that is extremely happy, doing well in school and has lots of friends. I don't think that is idiotic........

I'll preface this by stating that I'm a physician and am very aware of the interplay between big pharma and healthcare "providers".
We may want things to be black and white, but they're not. Disease is just being different from normal in some way. If this difference prevents one from functioning, it's a disease for sure. ADD and all of the subsets would likely be great coping mechanisms for certain situations. But we offer a world of speed-instant gratification, no waiting. Even my microwave is too slow. Then we expect kids to focus at school all day, doing work in 6th grade that I didn't do until medical school, and all the pathology shows up. Guess what, THEN WE EXPECT KIDS TO DO HOMEWORK. We are destroying our kids. I just want to work in the shop with my daughter and build a doll bed, but homework interferes. Given her SCT, there's nothing but homework and school. No playdates, no playing in the neighborhood until parents call you in for dinner. It's scary, but the diseases are real. They just aren't cured by pills, but the pills certainly help. The fact that medicine is a business is incongruous with what we expect from it.